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A  Consideration  of 
the  Introduction  of 
Surgical  Anaesthesia 


BY 

WILLIAM  H.  WELCH,  M.D.,  LL.D. 

Professor  of  Pathology 
Johns  Hopkins  Uni'versity 
Baltimore,    Maryland 


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The  Barta  Press,  Boston 


A    CONSIDERATION    OF    THE    INTRODUC- 
TION OF  SURGICAL  AN/ESTHFSIA.  * 

BY  WILLIAM  H.  WELCH,  M.I).,  LL.D. 
Professor  of  Pathology,  Johns  Hopkins  University,  Baltimore,  Md. 

It  is  a  happy  conception  of  the  trustees  and  staff  of 
the  Massachusetts  General  Hospital  to  set  apart  the 
sixteenth  of  October  as  "  Ether  Day,"  and  to  provide 
for  the  annual  public  celebration,  in  this  historic  place, 
of  the  anniversary  of  that  most  beneficent  gift  of 
medicine  to  mankind,  —  the  introduction  of  surgical 
anaesthesia.  I  esteem  it  a  high  honor  to  be  invited  to 
deliver  the  annual  address  in  commemoration  of  the 
great  event  v^^hich  took  place  within  these  walls  sixty- 
two  years  ago  to-day.  Of  the  significance  of  this 
event  there  can  be  no  question,  whatever  controversy 
there  may  be  concerning  the  exact  share  of  all  who 
participated  in  the  discovery  of  surgical  an2esthesia. 

The  attendant  circumstances  were  such  as  to  make 
the  operation  performed  on  Oct.  16,  1846,  in  the 
surgical  amphitheater  of  this  hospital,  by  John  Collins 
Warren,  upon  the  patient,  Gilbert  Abbott,  placed  in 
the  sleep  of  ether  anaesthesia  by  William  Morton,  the 
decisive  event  from  which  date  the  first  convincing, 
public  demonstration  of  surgical  anaesthesia,  the  con- 
tinuous, orderly,  historical  development  of  the  subject, 
and  the  promulgation  to  the  world  of  the  glad  tidings 
of  this  conquest  of  pain. 

Had  this  demonstration  or  any  subsequent  one  of 
like  nature  failed  of  success,  it  is  improbable  that  we 
should  have  heard  much  of  claims  to  the  prior  dis- 

_  *  Address  delivered  at  the  Massachusetts  General  Hospital  on  the 
sixty-second  anniversary  of  Ether  Day. 

3 


A  Consideration  of  the  Introduction  of  Surgical  An:vsthesia 

covery  of  surgical  aniesthesia.  Often  as  the  story  has 
been  told,  and  full  as  it  is  of  bitter  contro\ersy,  I  may 
l)e  permitted  to  recall  to  vour  minds  enough  of  the 
preceding  discoveries  and  ettorts  to  indicate  the  proper 
historical  settinp^  of  the  event  which  we  celebrate. 

When  and  by  whom  artificial  anaesthesia  was  dis- 
covered is  unknown.  It  is  certain  that  the  old  Greek 
and  Roman  physicians  were  acquainted  with  the  power 
of  various  narcotic  drugs  to  produce  insensibilitv  to 
pain  and  that  narcotic  potions  and  even  their  fumes 
were  frequently  administered  from  ancient  times 
onward  before  a  surgical  operation  in  order  to  lessen 
the  sufferings  of  the  patient.  At  a  later  period  more 
limited  use  was  sometimes  made  of  certain  devices 
for  the  same  purpose,  such  as  compression  of  the 
carotids,  the  tightening  of  a  tourniquet  and  pressure 
upon  nerve  trunks.  The  Elizabethan  dramatist, 
Middleton,  even  portrayed  an  age  of  surgical  anaes- 
thesia, when  he  wrote  in  one  of  his  plays  : 

"  rU  imitate  the  pities  of  old  surgeons 

To  this  lost  limb,  who,  ere  thev  show  their  art. 
Cast  one  asleep  ;  then  cut  the  diseased  part." 

But  we  know  that  none  of  these  procedures,  and 
"  not  poppy,  nor  mandragora,  nor  all  the  drowsy 
syrups  of  the  world  "  were  safe,  effective  and  avail- 
able agents  to  benumb  the  senses  during  a  surgical 
operation. 

The  history  of  the  events  connected  with  modem 
surgical  anaesthesia  begins  with  the  remarkable  devel- 
opment of  chemistry  in  the  latter  part  of  the  eighteenth 
century,  due  in  large  measure  to  the  discovery  and 
study  of  gases,  and  especially  with  the  discovery  of 
nitrous  oxide  by  Priestley  in   1776  and  the  investiga- 

4 


A  Consideration  of  the  Introduction  of  Surgical  Anx-sthesia 

tion  of  its  properties  l)y  Humphrey  Davy  at  the  end 
of  the  century  in  Dr.  Beddoes'  "  l^ieumatic  Insti- 
tute "  near  Bristol,  England.  At  this  period  there 
was  widespread  interest  in  England  in  the  study  of 
the  effects  of  inhalation  of  gases  of  different  sorts, 
particularly  of  the  newly  discovered  "  vital  air,"  or 
oxygen  and  nitrous  oxide,  and  exaggerated  ideas 
were  entertained  of  their  medicinal  virtues,  so  that 
there  arose  a  school  of  pneumatic  medical  practition- 
ers. The  institute  of  the  leader  of  this  school, 
Dr.  Beddoes,  is  now  chieffy  remembered  as  the 
place  which  afforded  to  Humphrey  Davy,  then  a 
young  man  who  had  commenced  the  study  of  medi- 
cine, the  opportunity  for  the  first  manifestations  of  his 
remarkable  genius  for  discovery  in  the  physical 
sciences. 

The  particular  discovery  which  here  concerns  us  is 
that  of  the  intoxicating,  and  especially  the  anaesthetic, 
properties  of  nitrous  oxide  gas,  made  in  Dr.  Beddoes' 
institute  and  vividly  portrayed  by  Davy  in  his  "  Re- 
searches, chemical  and  physical,  chieffy  concerning 
nitrous  oxide  and  its  respiration,"  published  in  1799. 
Here  is  found  the  memorable  and  often  quoted  sen- 
tence :  "  As  nitrous  oxide  in  its  extensive  operation 
seems  capable  of  destroying  physical  pain,  it  may 
probably  be  used  with  advantage  during  surgical 
operations  in  which  no  great  effusion  of  blood  takes 
place."  It  seems  to  us  to-day  amazing  that  this 
pregnant  suggestion  from  such  a  source  should  have 
passed  unheeded  and  that  tlie  application  of  Davy's 
discovery  should  have  been  delayed  for  over  forty 
years.  Davy's  interests  and  activities  were  soon 
transferred  at  the  Royal  Institution  to  fields  remote 
from  practical  medicine,  and  it  does  not  appear  that 

5 


A  Consiiieration  of  the  Introduction  of  Surgical  Anaesthesia 

he  made  any  further  eftort  to  bring  the  suggestion  to 
the  attention  of  surgeons. 

.  Observations  and  tests  of  the  intoxicating  effects  of 
the  inhalation  of  nitrous  oxide  were  from  tliis  time  on 
frecjuently  made,  and  there  is  repeated  mention  of  its 
ca})acity  to  produce  insensibihty  to  pain.  One  of  the 
most  dramatic  situations,  unnoticed  liitherto  in  the 
voluminous  literature  on  the  history  of  aniusthesia, 
is  the  occasion  when,  in  March,  1800,  William  Allen, 
the  accomplished  lecturer  on  chemistry  at  Guy's  Hos- 
pital, demonstrated,  in  the  presence  of  Astley  Cooper 
and  others,  the  phenomena  of  inhalation  of  nitrous  ox- 
ide, noting  especially  the  loss  of  sensation  to  pain. 
The  description  was  recorded  by  Allen  in  his  diary 
and  is  quoted  by  Wilks  and  Bettany  in  their  ' '  Biograph- 
ical History  of  Guy's  Hospital,"  The  great  surgeon 
had  eyes  but  he  saw  not  the  revelation  which  a  similar 
observation  brought  forty-four  years  later  to  the  poor 
and  unknown  dentist,  Horace  Wells,  in  Hartford, 
Conn, 

The  narcotic  properties  of  ether  —  a  body  known 
since  its  production  in  the  sixteenth  century  by  the 
German  physician,  Valerius  Cerdus  —  had  been  noted 
before  those  of  nitrous  oxide.  In  1795,  Dr.  Richard 
Pearson  recommended  and  employed  the  inhalation 
of  ether  in  pulmonary  consumption,  and  after  him 
Thornton,  John  Collins  Warren,  Nysten  and  others 
used  etherial  inhalation  for  the  relief  of  painful  affec- 
tions, especially  of  the  respiratory  tract,  including  that 
caused  by  the  accidental  inhalation  of  chlorine  gas. 
In  1818,  Faraday  pointed  out  that  the  inhalation  of  the 
v^apor  of  sulphuric  ether  produces  intoxicating  and 
stupefying  effects  similar  to  those  of  nitrous  oxide, 
and  in  Pereira's  "Materia  Medica,"  a  widely  read 

6 


A  Consideration  of  the  Introduction  of  Surgical  Anaesthesia 

and  authoritative  text-book  in  its  day,  first  published 
in  1839-40,  it  is  stated  that  "  if  the  air  be  too  strongly- 
impregnated  with  the  ether,  stupefaction  ensues." 

The  inebriating  properties  of  both  nitrous  oxide  and 
ether  became  widely  known,  not  only  to  the  medical 
profession,  but  also  to  the  general  public  by  their  fre- 
quent exhibition,  for  amusement  oftener  than  for  in- 
struction, in  chemical,  medical  and  popular  lectures. 
The  thirties  and  forties  of  the  last  century  were  the 
palmy  days  of  the  itinerant  lyceum  lecturer.  In  the 
laughing  gas  and  ether  frolics,  associated  sometimes 
with  these  lectures,  and  occurring  also  for  private  en- 
tertainment, an  acute  observer  might  note  that  intoxi- 
cated subjects  in  their  antics  often  barked  their  shins 
or  were  otherwise  injured  without  manifestations  of 
pain.  The  first  trials  of  anaesthetic  inhalation  to  annul 
the  pain  of  a  surgical  operation  came  from  the  inci- 
dental observation  under  such  circumstances  of  the 
benumbing  effects  of  ether  and  of  nitrous  oxide  gas. 

The  great  French  surgeon,  Velpeau,  doubtless  ex- 
pressed the  accepted  opinion  of  surgeons  before  the 
discovery  of  surgical  anaesthesia  when,  in  1839,  he 
wrote  :  "To  escape  pain  in  surgical  operations  is  a 
chimera  which  we  are  not  permitted  to  look  for  in  our 
day.  Knife  and  pain,  in  surgery,  are  two  words 
which  never  present  themselves  the  one  w^ithout  the 
other  in  the  minds  of  patients,  and  it  is  necessary  for 
us  surgeons  to  admit  their  association."  In  less  than 
a  decade  this  erring  prophet  hailed  before  the  Acad- 
emy of  Medicine  in  Paris  the  discovery  of  what  he 
had  called  a  chimera  as  "a  glorious  triumph  for 
humanity." 

For  several  years  before  the  invention  of  anaesthetic 
inhalation  for  surgical  purposes,  considerable  popular 

7 


A  Consideration  of  the  Introduction  of  Surgical  Anesthesia 

and  some  medical  interest  in  tlie  possibility  of  secur- 
ing unconsciousness  of  pain  during  a  surgical  opera- 
tion had  been  aroused  by  the  claims  of  the  mesmerists, 
and  there  seems  to  be  no  doubt  that  Esdaile,  in  East 
India,  and  others,  had,  in  certain  cases,  succeeded  in 
performing  painless  operations  in  hypnotic  sleep.  The 
metliod,  howe\er,  was  not  widely  api)licable  or  suc- 
cessful, and  the  general  attitude  of  the  profession 
toward  its  employment  is  sufficiently  sho\yn  by  the  joy 
of  the  eminent  surgeon,  Liston,  the  first  after  the 
dentist,  Robinson,  to  yerify  in  Great  Britain  the  dis- 
coyery  of  surgical  anaesthesia,  when  he  shouted, 
"Hurrah!  Rejoice!  Mesmerism  and  its  professors 
haye  met  with  a  hea^y  blow  and  great  discourage- 
ment. An  American  dentist  has  used  the  inhalation 
of  ether  to  destroy  sensation  in  his  operations  and  the 
plan  has  succeeded  in  the  hands  of  Warren,  Hay- 
ward  and  others,  in  Boston.  In  six  months  no 
operation  ^\  ill  be  performed  without  this  preyious 
preparation.      Rejoice  !  " 

It  has  been  sometimes  represented  that  the  inyen- 
tion  of  anaesthetic  inhalation  for  surgical  purposes  con- 
sisted in  nothing  more  than  the  application  to  this 
particular  use  of  knowledge  which  already  existed. 
This  yiew  falls  far  short  of  the  truth.  What  was 
known  of  the  anaesthetizing  properties  of  the  two 
agents  which  here  come  under  consideration — the 
yapor  of  ethyl-ether,  commonly,  although  incorrectly 
called  sulphuric  ether,  and  nitrous  oxide  gas  —  was 
enough  to  suggest  the  possibility  of  their  use  in  surgi- 
cal operations,  and,  as  I  haye  stated.  Sir  Humphrey 
Dayy  published  this  definite  suggestion  as  early  as 
1799.  Much  more  knowledge,  howeyer,  was  needed 
of  the  physiological  effects  of  these  agents  in  order  to 

8 


A  Consideration  of  the  Introduction  of  Surgical  An;j;sthesia 

demonstrate  their  applicability  as  safe,  efHcacious  and 
generally  available  surgical  anaisthetics.  The  only 
possible  sources  for  obtaining  this  additional  knowl- 
edge, as  well  as  that  which  had  already  been  acfjuired, 
were  experiments  upon  either  animals  or  man.  From 
both  of  these  sources  the  desired  knowledge  was  ob- 
tained, but  with  a  larger  use  of  experimentation  upon 
man  than  we  should  to-day  consider  justifiable. 

The  honor  of  making  the  first  trial  of  anaesthetic 
inhalation  in  surgical  operations  belongs  to  Dr.  Craw- 
ford W.  Long,  a  respected  and  honorable  country 
doctor,  then  living  in  Jefterson,  Jackson  County,  Ga., 
who,  in  March,  1842,  removed  painlessly  a  small 
tumor  from  the  neck  of  James  M.  Venable,  anaesthe- 
tized by  ether.  He  seems  to  have  performed  at  least 
eight  minor  surgical  operations  during  the  next  four 
years  upon  patients  under  the  influence  of  ether. 
Dr.  Long  is  necessarily  deprived  of  the  larger  honor 
which  would  have  been  his  due  had  he  not  delayed 
publication  of  his  experiments  with  ether  until  several 
years  after  the  universal  acceptance  of  surgical  anees- 
thesia.  It  is  also  to  be  regretted  that  his  published 
details  of  the  mode  of  administering  the  ether  and  the 
depth  of  the  anaesthesia  are  so  meagre  and  unsatisfac- 
tory. While  the  accepted  rule  that  scientific  dis- 
covery dates  from  publication  is  a  wise  one,  we  need 
not  in  this  instance  withhold  from  Dr.  Long  the  credit 
of  independent  and  prior  experiment  and  discovery, 
but  we  cannot  assign  to  him  any  influence  upon  the 
historical  development  of  our  knowledge  of  surgical 
anaesthesia  or  any  share  in  the  introduction  to  the 
world  at  large  of  the  blessings  of  this  matchless 
discovery. 

Until  the  prior  work  of  Dr.  Long  became  generally 

9 


A  Consideration  of  the  IntroJuction  of  Surgical  Anesthesia 

known,  largely  through  the  pul)lication  of  an  article 
by  Marion  Sims  in  1877,  altliough  the  announcement 
had  been  made  by  Long  in  1849,  and  more  fully  in 
1852,  the  credit  of  first  using  inhalation  of  an  effective 
ana.'sthetic  for  suru^ical  purposes  w  as  generally  assigned 
to  Horace  Wells,  a  dentist  of  Hartford,  Conn,  (im- 
pelled by  the  observation  of  apparent  loss  of  sensation 
to  pain  in  a  person  intoxicated  with  nitrous  oxide  g^s^ 
and  exhibited  at  a  lecture  by  Dr.  Gardiner  Q.  Colton 
in  December,  1844,  Wells,  the  following  day,  at  his 
own  request,  submitted  to  the  extraction  of  a  tooth 
while  under  the  influence  of  the  gas  and  experienced 
no  paini  He  at  once  began  the  use  of  nitrous  oxide  in 
extracting  teeth,  and  other  dentists  in  Hartford  used 
it.  Desiring  to  secure  larger  publicity  for  his  dis- 
covery, Dr.  Wells  went  to  Boston  in  January,  1845, 
and  was  given  the  opportunity  by  Dr.  Warren  to 
demonstrate  the  value  of  his  claims  before  him  and 
the  students,  Dr.  Morton,  his  former  partner,  being 
also  present.  Either  from  the  too  early  withdrawal 
or  the  inferior  quality  of  the  gas  this  test  was  a  tragic 
failure,  which  exerted  such  a  depressing  influence 
upon  W^ells  that  he  soon  withdrew  from  his  profes- 
sion, abandoned  his  experiments  and  four  years  later 
ended  his  own  life  under  most  distressing  circum- 
stances. From  what  we  now  know  of  the  valuable 
anaesthetic  properties  of  nitrous  oxide,  and  from  con- 
temporary evidence,  there  is  no  reason  to  doubt  that 
Horace  Wells  painlessly  extracted  teeth  by  its  use, 
and  that  if  he  had  persevered  in  his  efforts,  he  would 
have  been  able  to  perfect  the  method  of  producing 
anaesthesia  by  this  gas  and  to  demonstrate  to  the 
world  the  art  of  surgical  anaesthesia.  While  he  did 
not  achieve  this  complete  success,  the  credit  which 

10 


A  Consideration  of  the  Introduction  of  Surgical  Anaesthesia 

belongs  to  him  is  large  and  the  name  of  Horace  Wells 
should  always  l)e  held  in  honored  remembrance. 

Unlike  the  pioneer  work  of  Long,  that  of  Wells 
forms  a  direct  and  important  link  in  the  chain  of  dis- 
covery which  led  through  the  event  celebrated  here 
to-day  to  the  universal  adoption  of  surgical  anaesthesia. 
So  far  as  was  known  then  and  for  years  afterwards  to 
those  concerned  in  the  further  development  of  the 
subject,  Wells  was  the  first  to  take  the  step  to  which 
the  finger  of  Humphrey  Davy  had  pointed  forty-five 
years  before,  and  the  results  and  claims  of  Wells  were 
familiar  to  his  friend  and  former  partner,  Morton,  and 
must  have  stimulated  the  interest  of  the  latter  in  the 
possibilities  of  surgical  anassthesia,  although  Morton 
believed  that  the  particular  agent  used  by  Wells  was 
not  adapted  to  secure  this  end. 

The  significance  of  the  public  demonstration  of 
surgical  anaesthesia  in  this  hospital  sixty-two  years 
ago  to-day  does  not  depend  upon  the  settlement  of  the 
bitter  controversy  between  Charles  T.  Jackson  and 
William  Morton  concerning  their  respective  shares  in 
this  event.  I  deem  it,  however,  fitting  and  only 
historical  justice  to  say  that  in  my  judgment,  after 
careful  study  of  the  evidence,  the  greater  share  of  the 
honor  belongs  to  Morton.  This  was  the  prevailing 
opinion  of  those  most  competent  to  judge  and  best  ac- 
quainted with  the  facts  at  the  time,  the  trustees  and 
staff  of  the  Massachusetts  General  Hospital  and  the 
leaders  of  the  profession  in  this  city,  of  such  men  as 
John  Collins  Warren,  Jacob  Bigelow,  James  Jackson, 
Henry  J.  Bigelow,  Oliver  Wendell  Holmes,  George 
Hayward,  Henry  I.  Bowditch,  George  Shattuck, 
Walter  Channing,  John  Ware  and  many  others, 
although  it  is  only  fair  to  state  that  the  petition  in 

11 


A  Consideration  of  the  Introduction  of  Surgical  Amtfsthesia 

favor  of  Jackson's  claim  was  headed  by  the  honored 
name  of  Morrill  W'yman  and  contained  the  names 
of  manv  respected  physicians.  This  opinion  has 
remained,  I  believe,  the  prevailing  one,  not  only 
in  this  citv,  but  throughout  this  country.  The 
judgment  of  the  Paris  Academy  of  Sciences  in 
awarding  equal  honors  to  Jackson  and  to  Morton 
established  European  opinion  to  a  large  extent  up 
to  the   present  time. 

Morton  undoubtedly  received  helpful  suggestions 
from  Jackson,  w  ho  was  a  highly-trained  and  eminent 
chemist  and  geologist.  It  is  not  wholly  clear  to  what 
extent  these  contained  information  not  accessible  else- 
where, but  the  evidence  seems  conclusive  that  Morton 
was  indebted  to  Jackson  for  valuable  information 
w^hich  the  latter  had  acquired  by  personal  experience 
four  years  earlier  concerning  properties  of  ether, 
stronglv  suggesting  its  availability  for  surgical 
anaesthesia  ;  also  for  suggesting  the  use  of  chemically 
pure  rather  than  commercial  ether,  and  for  apparatus 
for  administering  the  ether.  There  is,  however, 
good  evidence  that  Morton,  while  reaching  out  for  all 
the  information  and  assistance  which  he  could  obtain 
from  different  sources,  acted  independently  and  con- 
ducted experiments  and  tests  with  ether  upon  his  own 
initiative  and  in  accordance  with  his  own  ideas.  The 
supposition  appears  to  me  irreconcilable  with  the  facts 
that  he  was  merely  a  hand  to  execute  the  thoughts  of 
Jackson. 

In  the  conflict  of  testimony,  there  is  not  likely  ever 
to  be  entire  agreement  of  opinion  concerning  the 
exact  measure  of  Morton's  indebtedness  to  Jackson, 
but  assigning  to  it  all  possible  weight,  and  remember- 
ing Humphrey  Davy  had  suggested  the  use  of  nitrous 

12 


A  Consideration  of  the  Introduction  of  Surgical  Anaesthesia 

oxide  for  surgical  anaesthesia  in  1799,  and  that  enough 
was  already  known  of  the  anaesthetic  properties  of 
both  ether  and  nitrous  oxide  to  have  led  Long,  in 
1842,  to  apply  the  former,  and  Wells,  in  1844,  the 
latter  to  painless  surgery  with  a  considerable  measure 
of  success,  it  seems  to  me  clear  that  the  chief  glory 
belongs  not  to  Jackson's  experiences  of  1842,  or  his 
thought  or  suggestion,  whatever  these  may  have  been, 
but  to  Morton's  deed  in  demonstrating  publicly  and 
convincingly  the  applicability  of  anaesthetic  inhalation 
to  surgical  purposes  and  under  such  fortunate  circum- 
stances that  the  knowledge  became,  as  quickly  as  it 
could  be  carried,  the  blessed  possession  of  the  whole 
world. 

There  are  circumstances  in  the  conduct  of  Morton 
as  well  as  of  Jackson  much  to  be  regretted  in  connec- 
tion with  this  great  discovery,  and  especially  is  it  to  be 
deplored  that  Morton,  the  least  heroic  of  great  dis- 
coverers, should,  if  only  for  a  short  time,  have  kept 
secret  the  nature  of  his  "letheon,"  and  that  he  and 
Jackson  should  have  patented  it. 

Participation  in  the  gift  of  surgical  anaesthesia  to  the 
world  brought  to  none  of  the  claimants  to  this  honor 
any  adequate  material  rewards  or  fame  during  their 
lives,  but  rather  the  stings  of  embittered  controversy, 
resulting  in  mental  derangement  in  the  case  of  two 
of  the  participants.  The  boon  of  painless  surgery  is 
the  greatest  gift  of  American  medicine  to  mankind 
and  one  of  the  most  beneficent  ever  conferred.  There 
is  a  growing  tendency  to  celebrate  the  gift  with  too  little 
thought  of  the  giver.  This  easy  procedure  is  doubtless 
due  to  the  difficulty  of  meting  out  equal  and  exact 
justice  to  all  concerned  and  to  disinclination  to  stir  the 
ashes  of  old  controversies.     This  disposition  of  the 

13 


A  Consideration  of  the  Introduction  of  Surgical  Anesthesia 

matter,  however,  is  unjust,  and  it  seems  to  me  tliat 
e\'ery  effort  should  be  made  to  determine  the  share 
and  the  credit  belonging  to  each  contributor  to  the 
discovery  and  the  introduction  of  surgical  anaesthesia, 
and  to  secure,  so  far  as  possible,  an  agreement  of 
opinion  in  this  important  matter.  We  are  not  likely 
to  come  into  possession  of  important  new  facts,  but 
their  unbiased  presentation  in  historical  order,  and  the 
consideration  of  their  relative  values  and  significance, 
should  clarify  professional  and  public  opinion  and 
enable  us  to  give  honor  where  honor  is  due.  One  of 
the  most  attractive  and  instructive  accounts  of  the 
ether  controversy  is  the  chapter  on  this  subject  in 
Dr.  Mumford's  charming  "Narrative  of  Medicine  in 
America,"  where  references  will  be  found  to  more 
detailed  statements  and  the  historical  documents.  I 
have  endeavored  in  this  brief  and  imperfect  historical 
survey  incidentally  to  express  in  some  measure  my 
personal  judgment  of  the  relative  importance  of  the 
leading  contributions,  and  my  conclusions  are  in  essen- 
tial agreement  with  those  of  Dr.  Mumford  when  he 
says  that  "  time  and  history  are  at  last  placing  the 
honor  where  it  belongs,  —  with  Morton,  who  for  his 
errors  most  certainly  was  punished  beyond  his  de- 
serts." But  whatever  may  be  the  differences  of  opin- 
ion, one  fact  of  the  first  historical  importance  stands 
and  will  continue  to  stand  unshaken  :  the  world  re- 
ceived the  gift  of  surgical  aucesthesia  as  the  immediate 
and  direct  result  of  the  convincing,  public  demonstra- 
tion of  its  efficacy  in  this  hospital  on  the  sixteenth  of 
October,  1846. 

In  the  bestowal  of  honors  the  name  of  the  eminent 
surgeon,  John  Collins  Warren,  should  not  be  for- 
gotten, who  had  the  courage  to  subject  his  patient  to 

14 


A  Consideration  of  the  Introduction  of  Surgical  Ansesthcsia 

unknown  risks  in  the  hope,  which  was  far  removed 
from  any  assurance,  that  a  great  blessing  was  about 
to  be  conferred  upon  suffering  humanity.  Great 
indeed  was  his  joy  in  the  fulfihnent  of  this  hope. 

Turning  now  from  these  historical  considerations, 
permit  me  to  direct  your  attention  to  certain  attributes 
of  the  discovery  of  surgical  anaesthesia,  and  certain 
lessons  to  be  drawn  from  it. 

It  is  to  be  emphasized  that  this  discovery  was  a 
triumph  of  the  experimental  method,  albeit  man  was 
made  the  principal  subject  of  experiment.  Animal 
experimentation  played  a  part,  for  I  see  no  reason  to 
question,  although  this  has  been  done,  Morton's 
statements  that  during  the  summer  of  1846  he  suc- 
cessfully anaesthetized  dogs  and  other  animals  with 
ether,  and  that  the  results  of  these  experiments  in- 
fluenced his  trial  of  the  anaesthetic  upon  human  beings. 
It  must,  however,  be  admitted  that  the  production  oi 
unconsciousness  in  man  by  ether  had  not  been  pre- 
ceded by  Such  numerous  and  properly  conducted  ex- 
periments on  animals  as  were  required  to  furnish 
adequate  conception  of  its  effects  or  its  possibilities 
of  danger.  Such  experiments  would  have  yielded 
knowledge  of  this  character,  and  we  know  that  at  the 
present  time  as  full  information  as  possible  would  have 
been  secured  from  this  source  before  administering  to 
man  an  agent  with  unknown  possibilities  of  danger, 
one  indeed  in  this  instance  stated  in  text-books  of  the 
time  to  be  dangerous  to  life  when  pushed  to  the  point 
of  producing  complete  unconsciousness.  If  the  oppo- 
nents of  animal  experimentation  attempt  to  utilize,  as 
they  have  done,  the  relatively  small  share  of  this 
method  of  advancing  knowledge  in  the  discovery  of 
surgical  anaesthesia,  the  only  implication  of  the  argu- 

15 


A  Consideration  of  the  Introduction  of  Surgical  Ansesthesia 

ment  is  that  thev  would  siihstitute  experiments  upon 
human  beings  for  those  uj)on  animals,  for  only  from 
one  or  the  other  of  these  sources  could  the  discovery 
have  been  derived. 

W'e  place,  then,  the  discovery  of  surgical  anaesthesia 
with  such  other  great  discoveries  as  those  of  the  cir- 
culation of  the  blood,  of  vaccination  against  smallpox, 
of  antiseptic  surgery,  of  antitoxin  and  man\  more 
among  the  great  contributions  to  the  w  elfare  of  man- 
kind made  by  the  use  of  that  indispensable  aid  to  the 
advancement  of  medical  science  art,  —  the  experi- 
mental method  of  investigation. 

A  quite  different  line  of  thought  suggested  by  the 
discovery  of  surgical  anaesthesia  is  the  aid  to  medicine 
which  comes  often  in  the  most  unexpected  ways  from 
discoveries  in  other  sciences.  Not  only  did  chemistry 
furnish  the  anaesthetic  agents,  but  the  wonderful  dis- 
coveries of  pneumatic  chemistry,  a\  hich  revolutionized 
the  whole  science  of  chemistry  in  the  latter  part  of  the 
eighteenth  century,  were  the  immediate  stimulus  to 
the  study  of  the  physiological  effects  of  various  gases, 
a  study  which  led  promptly  to  the  recognition  of  the 
anccsthetic  properties  of  nitrous  oxide  gas,  and  which, 
continued  through  half  a  century,  resulted  finally  in 
the  demonstration  of  the  applicability  of  certain  of 
these  gases  for  surgical  anaesthesia.  Here,  as  for  so 
many  other  gifts,  medicine  owes  a  large  debt  to  chem- 
istry, as  she  does  likewise  to  physics,  as  may  be 
exemplified  by  the  applications  of  the  Ra^ntgen  rays  in 
medical  and  surgical  diagnosis. 

While  it  does  not  appear  to  us  that  the  discovery, 
or,  as  some  prefer  to  say,  the  invention,  of  surgical 
anaesthesia  required  any  remarkable  intellectual  en- 
dowments or  high  scientific  training,  and  it  cannot  be 

16 


A  Consideration  of  the  Introduction  of  Siirpical  Anx-8the»ia 

said  that  Long,  Wells  or  Morton  were  possessed  of 
these,  it  was  the  outcome  of  a  spirit  of  incjuiry,  of 
keen  observation,  of  boldness,  of  perseverance,  of  re- 
sourcefulness, of  a  search  for  means  to  improve  a 
useful  art,  of  interest  in  the  practical  rather  than  the 
theoretical, —  all  traits  more  or  less  characteristic  of 
the  American  mind,  and  I  do  not  think  that  it  was 
wholly  an  accident  that  our  country  should  have  given 
birth  to  the  art  of  painless  surgery.  I  find  evidence 
of  this  view  in  the  fact  that  not  one  but  several 
Americans  were  working  independently  upon  the 
same  problem  and  that  the  solution  of  the  problem  is 
an  exclusive  achievement  of  our  countrymen. 

The  circumstance  that  a  long-awaited  discovery  or 
invention  has  been  made  by  more  than  one  investi- 
gator, independently  and  almost  simultaneously,  and 
with  varying  approach  to  completeness,  is  a  curious 
and  not  always  explicable  phenomenon  familiar  in  the 
history  of  discovery,  and,  as  in  the  case  of  surgical 
anaesthesia,  it  has  been  the  source  of  endless  and  often 
bitter  controversy.  Sooner  or  later,  often  long  after 
the  death  of  the  participants,  historical  justice  has 
usually  come. 

The  approach  to  a  great  discovery  is  long  and 
devious  and  marked  by  the  capture  of  a  barrier  here 
and  an  outpost  there  ;  when  the  fullness  of  time  has 
come  the  final  assault  is  often  made  by  more  than  one 
person,  and  the  victor  stands  upon  the  shoulders  of 
many  who  have  preceded  him, —  it  may  be  of  many 
who  have  fallen  by  the  way. 

The  period  when  surgical  anaesthesia  was  dis- 
covered was  one  full  of  the  spirit  of  scientific  inquiry 
and  the  opening  of  new  paths  for  medicine.  There 
had  come  to  be  a  general  realization  of  the   fact  that 

17 


A  Consiileration  of  the   Introtluction  of  Surgical  Anesthesia 

the  onlv  trustuorthy  sources  of  knowledge  are  exact 
observation  and  experiment.  The  great  impulse  de- 
rived from  the  introduction  of  tlie  new  methods  of 
physical  diagnosis  and  the  systematic  anatomical  study 
of  disease  had  shortly  before  reached  this  country 
from  France,  and  was  especially  active  in  this  city. 
Kxperimental  ])hysiology  and  j)harmacology  had  en- 
tered upon  fruitful  fields  of  exploration  through  the 
work  of  Magendie  and  of  Johannes  Miiller  and  their 
pui)ils.  The  foundations  of  cellular  pathology  were 
soon  to  be  laid.  While  it  is  not  apparent  that  those 
directly  concerned  in  the  discovery  of  surgical  anaes- 
thesia were  influenced  by  the  new  spirit  and  the  new 
ideas,  they  contributed  an  aid  to  experimental  research 
of  immeasurable  service.  It  was  fortunate  indeed  for 
the  public  demonstration,  reception  and  promotion  of 
the  discovery  of  surgical  anaesthesia  that  it  was  re- 
vealed to  that  able  group  of  surgeons  and  physicians 
then  connected  with  this  hospital,  \vho  were  imbued 
with  the  new  scientific  spirit  and  with  the  best  tra- 
ditions of  the  profession,  and  were  active  in  the 
advancement  of  the  art. 

A  consideration  of  some  interest  connected  wMth  the 
introduction  of  surgical  anaesthesia  is  the  influence  of 
en\ironment  and  of  material  conditions  upon  dis- 
covery. Here  we  find  illustrated  the  fact,  of  which 
there  are  many  examples,  that  apparently  adverse 
surroundings  and  average  intellectual  endowment 
without  special  scientific  training  constitute  no  barrier 
to  the  making  of  discoveries  of  the  highest  impor- 
tance to  mankind.  The  country  doctor  in  Georgia, 
with  only  an  ordinary  general  and  professional  edu- 
cation, and  the  two  poor  and  previously  unknown 
dentists    of   Hartford  and  of   Boston,    are   the   chief 

18 


A  ConHicleration  of  the   Introduction   of  Surj^irai  Anajsthcsia 

actors  in  the  dnima.  It  is  not  surprisini^  that  dental 
surgeons  should  have  been  particularly  eager  in  the 
quest  of  auicsthesia,  for  there  is  no  more  excruciating 
agony  than  the  pulling  of  an  aching  and  sensitive  tooth, 
and  the  short  duration  of  the  operation  and  the  suffering 
would  suggest  possibilities  of  success  which  might  not 
be  variable  in  a  prolonged  surgical  operation.  Nor  is 
it  surprising  that  American  dentists  should  have  been 
most  active  in  this  search,  when  we  recall  the  remark- 
able inventiveness  and  skill  which  have  characterized 
their  work  and  have  given  to  American  dentistry  a 
foremost  position  for  this  branch  of  surgery. 

On  the  other  hand,  however,  the  share  which  the 
Massachusetts  General  Hospital  and  its  surgeons  had 
in  the  demonstration,  promulgation  and  acceptance  of 
surgical  anaesthesia  exemplifies  the  value  of  a  favorable 
environment  and  was  largely  responsible  for  the  com- 
plete success  which  Morton  achieved  over  his  prede- 
cessors in  discovery.  The  manner  in  which  the 
surgeons  of  this  hospital  at  that  time  —  including  John 
Collins  Warren,  George  Hay  ward,  Henry  J.  Bigelow 
and  J.  Mason  Warren  — received  and  advanced  Mor- 
ton's demonstration  of  anaesthesia,  must  always  be  a 
source  of  pride,  not  only  to  this  hospital,  but  to  our 
country  and  the  world.  Especially  are  they  to  be 
commended  for  their  insistence  upon  disclosure  of  the 
nature  of  the  secret  letheon.  No  better  example  can 
be  found  of  the  service  which  a  great  hospital  and  its 
professional  staff  can  render  in  furthering  discovery 
and  in  advancing  and  spreading  new  knowledge  and 
new  methods  important  to  the  medical  and  surgical 
art  than  that  furnished  by  the  Massachusetts  General 
Hospital  in  its  relations  to  the  demonstration  and  intro- 
duction of   surgical  anaesthesia,  and  its    officers  and 

19 


A  Consideration  of  the  Introduction  of  Surpical  Anxsthesia 

staft  have  ever  remained  i'aithtul  to  the  high  ideals 
then  exemplified. 

\\  ortliv  of  especial  mention  are  tiie  first  announce- 
ment to  the  world  in  a  scientific  journal  of  the  great 
discovery,  by  Henry  J,  Rigelow  ,  in  an  imjx)rtant  paper 
read  before  the  American  Academv  of  Arts  and  Sci- 
ences, on  Nov.  3,  1846,  and  published  in  the  Boston 
Medical  and  Surgical  Journal  on  Nov.  18,  and  likewise 
Oliver  Wendell  Holmes'  delightful  j)art  in  coining 
the  w'ord  "anaesthesia,"  and,  indeed,  his  whole  atti- 
tude of  lively,  sympathetic  and  imaginative  interest, 
as  expressed  in  all  that  he  said  and  wrote  concerning 
the  new  discovery.  A  sentence  often  quoted  will 
suffice  to  illustrate  Dr.  Holmes'  appreciation  of  the 
benefits  of  the  discovery,  as  well  as  his  powers  of 
vivid  description  : 

"The  knife  is  searching  for  disease,  the  pulleys 
are  dragging  back  dislocated  limbs,  nature  herself  is 
working  out  the  primal  curse  which  doomed  the  ten- 
derest  of  her  creatures  to  the  sharpest  of  her  trials, 
but  the  fierce  extremity  of  suffering  has  f^een  steeped 
in  the  waters  of  forgetfulness,  and  the  deepest  furrow 
in  the  knotted  brow  of  agony  has  been  smoothed 
forever." 

The  reception  of  the  joyful  discovery  was  every- 
where enthusiastic,  although  not  without  some  of  the 
mutterings  which  come  from  those  petrified  against 
all  innovations,  as  appears  from  remarks  made  by 
Professor  Miller  to  his  class  in  London  not  long  after- 
ward. "The  profession,"  he  says,  "  were  surprised, 
excited,  charmed  in  the  mass,  and  more  especially 
those  on  the  junior  side  of  the  grand  climacteric.  The 
elderly  gentlemen  had  their  preconceived  and  hereto- 
fore settled  notions  sadly  jostled  and  disturbed.     Not 

20 


A  Consideration  of  the  Introduction  of  Surgical  Anae»the«ia 

a  few  grew  irritable  and  resented  the  interference  ; 
they  closed  their  ears,  shut  their  eyes  and  folded 
their  hands ;  they  refused  to  touch  or  in  any  way 
meddle  with  the  unhallowed  thing  ;  they  had  quite 
made  up  their  minds  that  pain  was  a  necessary  evil 
and  must  be  endured  ;  they  scouted  on  the  attempted 
innovation  and  croaked  that  '  no  good  could  come  of 
it.'     On,  notwithstanding,  sped  the  movement." 

One  of  the  most  extraordinary  aberrations  of  the 
human  mind  was  manifested  by  the  raising  of  religious 
scruples,  particularly  against  the  abolition  of  pain  in 
childbirth.  Sir  James  Simpson,  the  discoverer  of  the 
anassthetic  uses  of  chloroform,  and  of  important  service 
in  advancing  the  art  of  anaesthesia,  quotes  from  the 
letter  of  a  clergyman,  who  declares  that  chloroform 
is  "  a  decoy  of  Satan,  apparently  offering  itself  to  bless 
women,  but  in  the  end  it  will  harden  society  and  rob 
God  of  the  deep  earnest  cries  which  arise  in  time  of 
trouble,  for  help."  If  this  clergyman  remembered 
the  primal  curse,  he  forgot  the  earliest  example  of 
anaesthesia  when,  in  the  resection  of  a  rib  for  the 
creation  of  Eve,  "the  Lord  God  caused  a  deep  sleep 
to  fall  upon  Adam," 

The  immediate  immeasurable  benefits  conferred  by 
anaesthesia  in  the  relief  of  human  suffering  were  real- 
ized more  fully  and  were  expressed  more  adequately 
by  the  generation  which  knew  by  experience  the  con- 
trast between  the  old  surgery  and  the  new  painless 
surgery  than  is  possible  for  us  to-day.  But  of  all  the 
blessings  which  were  to  flow  from  this  priceless  gift 
there  could  be  only  a  feeble  conception  sixty  years 
ago,  and  as  this  flow  is  unceasing,  we,  ourselves, 
cannot  fully  estimate  them.  Anaesthesia  and  anti- 
sepsis, the  two  greatest  boons  ever  conferred  upon 

21 


A  Consideration  of  the  Introiluction  of  Surpical  Anaesthesia 

the  surgical  art,  liave  made  possible  the  marvelous 
developments  of  surgery  during  the  last  forty  years, 
and  only  by  their  aid  can  surgery  continue  to  advance. 

1  have  somewhere  seen  a  statement  to  the  effect 
that  the  introduction  of  anitsthesia  and  of  antisepsis 
have  made  the  practice  of  surgery  so  certain  and  so 
easy  that  qualities  of  hand  and  of  mind  u  hich  were 
essential  to  high  success  in  the  practice  of  pre-anaes- 
thetic  surgery,  and  which  were  exhibited  by  the  sur- 
gical heroes  of  old,  are  no  longer  necessary,  so  that 
even  commonplace  mortals  can  now  become  surgeons. 
There  is  perhaps  a  half  truth  in  this,  but  it  is  more 
than  compensated  for  by  the  demands  upon  the  skill 
and  judgment  of  the  modern  surgeon  in  the  perform- 
ance of  operations  vastly  more  difficult  than  any  w  hich 
were  possible  or  were  dreamt  of  in  the  old  days. 

What  surgery  was  before  the  days  of  ansesthesia, 
and  what  anaesthesia  has  done  for  surgery  and  for 
obstetrics,  are  subjects  which  were  presented  at  the 
semi-centennial  anniversary  of  anaesthesia  in  this 
hospital  by  Dr.  Ashhurst,  Dr.  Cheever  and  Dr.  Rey- 
nolds, men  far  more  competent  to  deal  with  them 
than  I  am.  On  the  same  occasion  I  had  the  privilege 
of  speaking  on  the  influence  of  anaesthesia  upon  medi- 
cal science,  and  I  shall  not  now  consider  this  aspect  of 
the  subject,  save  to  note  again  in  passing  that  physi- 
ology and  experimental  medicine  in  their  special  fields 
have  derived  benefits  from  anaesthesia  comparable  to 
those  enjoyed  by  surgery.  That  the  useful  knowl- 
edge which  can  come  only  from  experimentation  upon 
animals  can  now  be  acquired  in  by  far  the  larger  part 
without  the  infliction  of  pain  is  a  source  of  immense 
satisfaction. 

Ushered  in  by  the  discovery  of  vaccmation  against 

22 


A  Consideration  of  the  Introduction  of  Surj^ical  Ana.-.stliesia 

smallpox  at  the  close  of  the  eighteenth  century,  the 
greatest  practical  achievements  in  our  art  during  the 
nineteenth  century  were  anaesthesia,  antiseptic  surgery 
and  the  power  to  control  infectious  diseases  resulting 
from  the  discovery  of  their  living  contagia  —  achieve- 
ments surpassing  the  heritage  of  all  the  centuries 
which  had  gone  before  in  the  saving  of  human  life  and 
the  alleviation  of  suffering.  Of  all  these  gifts  of 
medicine  to  mankind,  the  sweetest  and  the  happiest 
is  that  "  death  of  pain"  so  beautifully  portrayed  at 
the  semi-centennial  anniversary  of  anaesthesia  by  our 
beloved  poet-physician,  Wier  Mitchell : 

'*  Whatever  triumphs  still  shall  hold  the  mind, 
Whatever  gift  shall  yet  enrich  mankind. 
Ah  !  here  no  hour  shall  strike  through  all  the  years, 
No  hour  as  sweet,  as  when  hope,  doubt,  and  fears, 
'Mid  deepening  stillness,  watched  one  eager  brain. 
With  Godlike  will,  decree  the  Death  of  Pain." 

To  these  fine  lines  I  can  add  in  closing  no  more 
fitting  words  than  those  of  John  Collins  Warren,  who 
presided  over  the  scene  enacted  here  sixty-two  years 
ago,  a  name  ever  to  be  honored  in  this  place  and 
throughout  the  civilized  world.  These  words,  spoken 
soon  after  the  event  which  we  celebrate,  retain  their 
vigor,  freshness  and  truth  to  this  day.      He  said  : 

"A  new  era  has  opened  on  the  operating  sur- 
geon. ...  If  Ambrose  Pare  and  Louis  and  Dessault 
and  Cheselden  and  Hunter  and  Cooper  could  see  what 
our  eyes  daily  witness,  how  would  they  long  to  come 
among  us  and  perform  their  exploits  once  more. 
And  with  what  fresh  vigor  does  the  living  surgeon, 
who  is  ready  to  resign  the  scalpel,  grasp  it  and  wish 
again  to  go  through  his  career  under  the  new  auspices. 

23 


A  Consideration  of  the  Introduction  of  Surgical  Anaesthesia 

As  philanthropists  we  may  well  rejoice  that  we  have 
had  an  agency,  however  slight,  in  conferring  on  poor 
suffering  humanity  so  precious  a  gift.  Unrestrained 
and  free  as  God's  own  sunshine,  it  has  gone  forth  to 
cheer  and  gladden  the  earth  ;  it  will  awaken  the 
gratitude  of  the  present  and  of  all  coming  generations. 
The  student,  who  from  distant  lands  or  in  distant 
ages,  may  visit  this  spot,  will  view  it  u  ith  increased 
interest,  as  he  remembers  that  here  was  first  demon- 
strated one  of  the  most  glorious  truths  of  science." 


24 


COLUMBIA  UNIVERSITY  LIBRARY 


This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 


DATE  BORROWED 


AUG  1  a  1940 


DATE  BORROWED 


J)CT  14  ia4t 


-mv 


t-^:.  5195Q. 
3ECl41aD 

3EC21Vj:>L' 

Dl'w    ■ 


17 


H^ 


C«  V 


ML 


C2ei23»IMI00 


RD79 
Wei  oh 


VI44 


A. 


A  consideration  of  the  intro- 
duction of  surgical  anaesthesia 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stx) 

RD79W44C.1 

A  consifliTntinii  dI  tlif  iiitiiifliirtirni  rif ', 


2002190656 


